The Quarterly journal of medicine
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Defects of the human mitochondrial respiratory chain have been associated with several diseases including, most recently, certain neurodegenerative disorders. Several studies have used platelet mitochondrial function as a means to determine the potential contribution of respiratory chain defects to the pathogenesis of Parkinson's disease. Platelet biochemistry is subject to modulation by numerous factors that may circulate in the blood, including environmental agents, some of which may be relevant to mitochondrial dysfunction and neuronal toxicity. ⋯ The results offer a novel mechanism of action for the cellular toxicity, or even mutagenicity, associated with cigarette smoking. In addition, these data have important implications for the interpretation of platelet mitochondrial complex I activities in disease states. They are particularly relevant to our interpretation and understanding of the complex I deficiency in Parkinson's disease platelets.
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The use of 'do not resuscitate' (DNR) orders was analysed on a Dutch geriatric ward for a 4-month period. Of 148 admissions, 68 (58%) received a written DNR order. The use of DNR orders was significantly influenced by age (> 83 years) and the pre-arrest morbidity (PAM) index. ⋯ Only 3% of patients and 24% of families were involved in the DNR decision. Disagreement with the residents' decisions was 20% for staff nurses and 17% for consultants. Physicians use factors besides comorbidity to make DNR decisions, and further study of such factors is necessary for the development of standardized DNR policies.
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Malignant hyperpyrexia is an inherited disorder of skeletal muscle characterized by intermittent hypermetabolic crises, usually triggered by anaesthetic agents. We present the case of a 19-year-old man who developed acute renal failure following an apparently uneventful general anaesthetic for appendicectomy. ⋯ Both the patient and his father were later discovered to have an underlying metabolic susceptibility to malignant hyperpyrexia. We propose that an undetected hypermetabolic crisis precipitated rhabdomyolysis and subsequent acute renal failure in this patient.
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Helicobacter pyloris is considered to be aetiologically implicated in gastritis and peptic ulceration, since if H. pyloris infection can be eradicated the risk of subsequent ulcer relapse is markedly reduced. The rate of 'reinfection' following treatment ranges from 0% to 45%, but its origin remains controversial (reappearance of uneradicated original infection or a fresh infection). To distinguish temporary suppression of H. pylori from fresh infection we conducted a retrospective analysis of the criteria used to establish eradication of the original infection in 304 patients. ⋯ All 'reinfections' occurred within 24 months of the original treatment. 'Reinfection' was uncommon in patients receiving powerful therapeutic regimens (e.g. triple therapy) compared with those receiving monotherapy or relatively ineffective dual therapy combinations. In patients whose urea breath test remains negative 12 months after treatment the subsequent reinfection rate is only 0.44%/year. This supports the strategy of eradicating H. pylori infection from suitable peptic ulcer patients.